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Biomedical subjects

F A Frizelle

Publications and source records attributed to F A Frizelle.

At least 19 recordsLinked to original sources
PubMed1999

Protective effect of appendectomy on the development of ulcerative colitis: matched, case-control study.

PURPOSE: Appendectomy and cigarette smoking have been suggested to reduce the chance of developing ulcerative colitis. A case-control study was undertaken to determine the relative incidence of appendectomy in patients with ulcerative colitis. METHODS: This case-control study examined the incidence of appendectomy in patients with ulcerative colitis and patients attending an orthopedic outpatient clinic. RESULTS: Of 100 patients with ulcerative colitis, 75 pairs were matched for age, gender, and cigarette smoking. The ulcerative colitis group had an appendectomy rate of 8 percent (6/75), compared with 21 percent in the control group (P = 0.018). The odds ratio was 3.5 (95 percent confidence interval, 1.15-10.6). CONCLUSIONS: No previous study has examined the effect of appendectomy, controlling for cigarette smoking. This study confirms that appendectomy protects against or reduces the chance of development of ulcerative colitis. A possible immunological explanation for this effect is advanced.

Adolescent↗
PubMed1999

Risk factors for post-appendicectomy intra-abdominal abscess.

BACKGROUND: Appendicectomy is a common emergency operation, after which major complications are uncommon, however when they do occur they are a major cause of concern to patient and surgeon. This study aims to determine the incidence and risk factors for post-appendicectomy intra-abdominal abscess formation. METHOD: A retrospective review was undertaken of all appendicectomies undertaken in Christchurch Hospital between 1 January and 31 December 1995. Appendicectomies were identified from a database of histology. The patients' notes were reviewed and the surgical approach, histological diagnosis and postoperative complications identified. RESULTS: A total of 417 appendicectomies was identified of which 331 were open, 66 laparoscopic, and 20 undertaken at laparotomy. Mean day stays for each group were 4.4, 4.2 and 11.5 days, respectively. The percentages of patients with acute appendicitis in each group were 87, 58 and 35%. Histologically the appendix was inflamed in 80% (334) of patients (acute 232, chronic 15, perforated 56 and gangrenous 24). There were six postoperative intra-abdominal abscesses (1.4%), all occurring in the open appendicectomy group when the histology was either perforated or gangrenous appendicitis (P < 0.001). There were no cases of postoperative abscess formation following laparoscopic appendicectomy. All cases of postoperative intra-abdominal abscess were associated with perforated and/or gangrenous appendicitis (P < 0.001). The incidence of intra-abdominal abscesses was 7.5% with a perforated and/or gangrenous appendix. There were two cases of iatrogenic perforation following laparoscopic appendicectomy. CONCLUSION: The incidence of intra-abdominal abscess is 1.4% of all appendicectomies. The only identified risk factor for development of post-appendicectomy intra-abdominal abscess was the underlying pathology of gangrenous or perforated appendicitis.

Abdominal Abscess↗
PubMed1998

Informed consent: what do patients want to know?

AIM: To determine which aspects of informed consent are important to patients and surgeons and to determine where there is disparity and similarity. METHOD: A questionnaire was developed from the Disability Commissioner's Regulations (1996) and was administered to 256 patients and 37 doctors at Christchurch Hospital. RESULTS: According to patients the five most important aspects of informed consent were: (1) the major risks, (2) quality of life, (3) outcome, (4) consequences of not undergoing the procedure and (5) quantity of life. The five most important aspects to the doctors were (1) the general nature of the procedure, (2) major risks, (3) consequences of not undergoing the procedure, (4) alternative options and (5) consequences of the procedure in regard to management. The aspects of informed consent of greatest divergence (power of divergence, p < 0.05) between patient and doctor were (1) the importance of technical details of the procedure, (2) cost to the country, (3) qualifications of the doctor, (4) experimental and non-conventional treatment options and (5) whether the doctor would have the procedure if they were in the position of the patient. CONCLUSIONS: This study has identified aspects of informed consent that patients and doctors consider important, as well as aspects where there are significant differences. Both patients and doctors consider the explanations of risks and complications important, especially if the complication is serious and risk is greater than 1 in 1000. Patients consider aspects of outcome (quantity and quality of life) important, while doctors are concerned about "process" including the general nature of the procedure and consequences of the procedure for the patient's management. This study gives direction to medical practitioners concerning what it is that patient's are wanting to know during informed consent about a procedure.

Adult↗
PubMed1998

Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies.

BACKGROUND: Appendiceal tumors are rare and often unexpectedly discovered in an acute situation, in which decision-making is difficult. To help define the most appropriate management, a retrospective analysis was undertaken to describe the clinicopathologic behavior of appendiceal tumors, and the literature was reviewed of the management of the different types of appendiceal tumors. METHOD: From a single center, a histopathologic database of 7,970 appendectomies, all appendiceal tumors, were identified and case notes reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 16-year period (7,970 appendectomies), 74 patients (0.9 percent) with appendiceal tumors were identified: 42 carcinoid, 12 benign, and 20 malignant. Acute appendicitis was the most common presentation (49 percent), and 9.5 percent were incidental findings. Primary malignant tumors of the appendix were found in 0.1 percent of all appendectomies. Secondary malignant disease was identified in the appendix of 11 patients, most commonly (55 percent) from patients with primary colorectal disease. There was a high incidence of synchronous and metachronous colorectal cancer in all appendiceal tumors: carcinoids, 10 percent; benign tumors, 33 percent; secondary malignancies, 55 percent; primary malignancies, 89 percent. CONCLUSION: Appendiceal tumors are uncommon and most often present as appendicitis. Most are benign and can be managed by appendectomy, except adenocarcinomas and carcinoids larger than 2 cm, which are most appropriately managed by right hemicolectomy. A suggested management algorithm is provided. Controversy exists over the management of carcinoids 1 to 2 cm in size and adenocarcinoids. All types of appendiceal tumors have a high incidence of synchronous and metachronous colorectal cancer.

Adenocarcinoma↗
PubMed1998

Giant colonic diverticulum: report of four cases and review of the literature.

PURPOSE: Giant colonic diverticulum are rare, with 103 reported cases in 95 patients. The experience of any one surgeon is limited. We aimed to retrospectively review our experience and to review the literature on origin, pathology, and management of this rare and unusual problem. METHOD: Cases were identified by review of pathologic database and by computerized audit from three hospitals. RESULTS: Five giant colonic diverticulum were identified in four patients, and the pathology and management were reviewed. CONCLUSION: A definition and classification system of giant colonic diverticulum is suggested. Giant colonic diverticulum should be the universal term to cover all colonic diverticulum larger than 4 cm, and we suggest that there are two types based on histology. Literature review reveals 103 reported cases in 95 patients. Type I (87 percent) is a pseudodiverticulum, perhaps related to conventional diverticular disease, whereas Type II (13 percent) is a true diverticulum, which is probably a type of communicating cystic congenital duplication. These lesions tend to occur in the sigmoid colon (93 percent) and present with complications similar to conventional diverticular disease. In the presence of conventional diverticular disease, consideration should be given to anterior resection, and in the absence, diverticulectomy should be considered.

Aged↗
PubMed1998

Tumour cell wound distribution after colectomy in a porcine model.

BACKGROUND: Concerns over tumour implants have impeded the adoption of laparoscopic surgery for cancer. Explanations assume an increased number of malignant cells present in trocar wound sites. The following are tested in the present paper: (i) that the magnitude of wound contamination following surgery is related to the location of the tumour cells; and (ii) the surgical approach. METHODS: We have used a porcine sigmoid colectomy model to compare the number of tumour cells on laparoscopic wounds after resections in the presence of intraluminal, intramural and intraperitoneal 51Cr-labelled, fixed HeLa tracer cells. Open colectomies were also performed in the presence of intraperitoneal tracer cells and their numbers on laparotomy wound surfaces were determined by gamma counting. RESULTS: With intraperitoneal cells, laparotomies had 1087 (+/- 106) tracer cells per mm (n = 4) while trocar wounds had 103 (+/- 54) cells per mm (n = 10) (P > 0.05). Resection of intramural tumours resulted in lower trocar wound contamination (0.9 +/- 0.6 cells/mm, n = 3). Resection of colon including intraluminal tracer cells resulted in 2.9 +/- 2.1 cells/mm on trocar wounds (n = 3). CONCLUSIONS: More tumour cells were deposited on open than laparoscopic trocar wound surfaces. Also, the risk of wound implantation is less with intraluminal or intramural tumours than with intraperitoneal cells (P > 0.05).

Animals↗
PubMed1997

Perianal Bowen's disease: associated tumors, human papillomavirus, surgery, and other controversies.

BACKGROUND: Perianal Bowen's disease (BD) is an intraepithelial nonkeratinizing carcinoma, associated historically with internal tumors. METHODS: A review of patients with perianal BD presenting consecutively during a 25-year span was undertaken, excluding Bowenoid papulosis and contiguous genital BD. Histologic slides were resubmitted for review by an experienced pathologist, in a "blind" fashion among other slides. Follow-up was updated in every patient. Survival and recurrence curves were generated by the Kaplan-Meier method and were compared with a normal age-matched population (log-rank test). RESULTS: Nineteen patients were identified; 15 of them were females. Mean age +/- standard deviation was 49.6 +/- 10.6 years. Five patients had a coincidental diagnosis (hemorrhoidectomy or wart excision). No associated carcinomas were found; however, eight patients had isolated BD of the vulva. Eleven patients had a history of anal warts, cervical/vulvar dysplasia, or both. Wide resection, including V-Y flaps, was performed in 18 patients without dysfunction. One-year and five-year recurrence was 16 and 31 percent. Recurrence was treated in all but one case by wider resection. Mean follow-up was 8.4 years. Five-year survival was 75 percent, lower than the matched population (P = 0.001); however, only one death was related to BD. CONCLUSIONS: Perianal BD has no association with internal tumors. Despite a high rate of recurrence, perianal BD can be treated by local excision. An increased rate of human papilloma virus-related entities was found, which could suggest a causative role.

Anus Diseases↗
PubMed1997

Paget's disease of the perianal region--an aggressive disease?

BACKGROUND: Perianal Paget's disease is a rare entity, often associated with internal malignancies and a poor prognosis. METHODS: A chart review of patients with perianal Paget's disease who presented consecutively to Mayo during 25 years (starting in January 1970) was made. Patients included had Paget's disease located in or around the anus (3 cm). Patients were excluded for evidence of spread of vulvaperineal lesions or pagetoid extension of a rectal adenocarcinoma. Histology slides were reviewed, and immunohistochemistry was applied to confirm diagnoses. Follow-up was updated in all patients. Recurrence and survival curves were generated by the Kaplan-Meier method. Survival was compared with an age-matched population by the log-rank test. RESULTS: Thirteen patients, eight females, were diagnosed (age +/- standard deviation of 68.3 +/- 10.6 years). All histologic diagnoses were confirmed with immunohistochemical staining results. Mean follow-up was 6.7 years, 8.8 for living patients. One patient had associated extramammary Paget's disease (scrotum). Lesions were located randomly at the dentate line, anal verge, and/or perianal area. Four patients had associated carcinomas; none of them were visceral. Eleven patients underwent local resection, without adjuvant therapy. Almost all recurrences were treated by wider local excision. The five-year recurrence rate was 61 percent. Overall five-year and ten-year survival was 67 percent, no different from the age-matched population (P = 0.546). CONCLUSIONS: These results do not reflect an aggressive nature of perianal Paget's disease, despite a high rate of local recurrence. Both primary lesions and recurrences are susceptible to treatment by wider local resection. Long-term survival is no different from that of the normal age-matched population.

Aged↗
PubMed1997

Congenital caecal cystic duplication presenting with caecal volvulus in an elderly woman.

Congenital caecal cystic duplication of the gastrointestinal tract usually present during infancy or young childhood. We have identified a patient who presented at 91 years of life with a caecal volvulus caused by a large communicating caecal cystic duplication. Review of the literature shows that caecal cystic duplications become symptomatic early when they cause complications, but until this report, volvulus was not a recognised presentation of caecal cystic duplication.

Aged↗
PubMed1997

Comparison of direct monocular endoscopic, two- and three-dimensional display systems on surgical task performance in functional endoscopic sinus surgery.

Surgeons performing functional endoscopic sinus surgery (FESS) traditionally rely on direct endoscopic viewing through a single monocular Hopkins rod lens telescope. While the majority of surgeons have found this satisfactory, most other endoscopic surgical specialties have moved to 2-D video endoscopy, where a monoscopic image is presented on a television monitor. This study set out to determine whether 2-D or 3-D display systems had any advantage over direct endoscopy in FESS. Ten otolaryngology trainees performed a series of standardized procedures on a FESS model using direct endoscopic vision, 2-D and 3-D. A performance score was obtained by dividing the execution time by the number of tasks achieved. There was a significant difference in both surgical and diagnostic task performance with 2-D (mean scores 56.8 and 41.1) performing better than direct endoscopy (mean scores 94.1 and 74.1) (P < 0.05). Tasks were also performed significantly better with 3-D compared with 2-D (P < 0.05).

Endoscopy↗
PubMed1997

Review: the surgical management of ulcerative colitis.

The treatment of ulcerative colitis requires careful review of the medical and surgical options. The surgical procedure of choice is proctocolectomy with ileal pouch-anal anastomosis. This procedure removes the diseased mucosa, effectively curing the disease whilst maintaining the normal route of defecation and continence. Other surgical options that may be considered in selected patients include proctocolectomy with either a Brooke ileostomy or a Kock pouch, and abdominal colectomy with ileorectal anastomosis. The choice of operation requires consideration of the advantages and disadvantages of a particular procedure and must be tailored to an individual patient's needs and circumstances.

Colectomy↗
PubMed1997

Management of post-operative recurrent diverticulitis: a review of the literature.

Recurrent abdominal symptoms following resection for diverticular disease occur in 1-10% of patients. Not all of these patients have recurrent diverticulitis. Other conditions such as carcinoma, irritable bowel syndrome, inflammatory bowel disease and ischaemic colitis should be considered in the differential diagnosis. A thorough investigation including computerized tomography (CT) scanning, contrast studies and colonoscopy must be undertaken. The cause of recurrent diverticulitis may be the result of inadequate previous resection or progression of disease. Re-resection has been required in 0-3.1% of patients in a collected series. Re-resection may be technically demanding although permanent colostomy is usually not necessary. The best method of prevention is adequate initial resection.

Carcinoma↗